Provider Demographics
NPI:1750552352
Name:HURZELER, KIMBERLY ERIN (CPCI)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:ERIN
Last Name:HURZELER
Suffix:
Gender:F
Credentials:CPCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3875 S BOBOLINK ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-1209
Mailing Address - Country:US
Mailing Address - Phone:801-449-0585
Mailing Address - Fax:801-982-1365
Practice Address - Street 1:2860 W 4700 S STE B
Practice Address - Street 2:
Practice Address - City:TAYLORSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84129-2159
Practice Address - Country:US
Practice Address - Phone:801-449-0585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-22
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6651643-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health